I love the helping the patients but.....

[HigginsdogRN]

I've been working on the acute admissions unit of a state psychiatric facility for 4 months now. First of all we are an all paper facility. This is so tedious and there is so much redundancy and time wasted running forms here and there. looking for forms and transcribing illegible orders waiting for doctor s to come by and write orders or clarify orders. papers ripping out of mars. written errors crossed out in our nursing notes. frankly the whole system is a meaningless mess of terrible documentation. Most of our nursing notes are useless because most of our nurses don't even talk to the patients.

That is bad enough but, the attitude of most of the nurses is so lacki9ng in empathy that I'm astounded. I was matched with an RN II to "supervise" me through my first few months. One of the first shifts I worked with him. he as the charge nurse made the unit schedule. He put me to run a wrap up group in the dayroom at a certain time. So at that time, I did just that. He walked by during this and saw me and called me to the nurses station. I went over there and he said to me, "you can talk to these people until you are blue in the face but you are never going to help them." I said, UH....I'm running the group you signed me up for." He said, " We never do those groups, they are a waste of time." We never take them out for the state required fresh air breaks and when they as for them they are always told no. If the become indignant and say that they have the right and start to become upset, they are offered po meds for psychotic agitation if they refuse we restrain them and force IM.

Since then, I have been pressured to fudge our seclusion and restraint 15 minute documentation to keep them in longer than they release criteria. I refused. Problem is, the whole facility is a farce. There is such an adversarial relationship between the nursing staff and the patients. I am dismayed and shocked at the way thy are talked to and treated. There is more escalation by power hungry tyrants then by psychotic aggression. I'm so frustrated by the lack of dignity that I am applying elsewhere already. The thing is, I need a job but at the same time I think that I am complicit by not whistleblowing to the governing body about what is happening here that I don't know what to do.

Is this the way it is inpatient psych? Is the whole system, least restrictive, patient directed recovery all a big bunch of bull?

[Jacob Rockstar-RN]

If you are to help one, you must attempt to help all. If what you describe is what's truly what's taking place across the board in this facility, then your responsibility as a competent professional is to report the goings on to the proper monitoring agency as well as a patient advocacy group. Your patients deserve better.

[Davey Do]

Is this the way it is inpatient psych? Is the whole system, least restrictive, patient directed recovery all a big bunch of bull?

No, Inpatient Psych is not this way everywhere, I'm Happy to say. In fact, all three Inpatient Psych Facilities where I have been Employed have Therapeutic Treatment as their Goal.

HOWEVER, in the Past, certain Individuals in Charge have Utilized Inappropriate, or Substandard Methods to meet Certain Goals. Objective Documented Reporting, Following the Chain of Command, and Utilizing Inhouse, and eventually, Outside Resources, have Improved or Rectified Problem Situations, in my Experience.

One must be ready to be seen as a Whistleblower or Snitch or the Bad Guy or Whatever in Order to Change Things.

Following the Philosophy of Self-Satisfaction has been my Mainstay. Self-Satisfaction, being Happy with Myself, is not Contingent on what Others Do or Say, or What Happens Around Me. My Happiness comes from Being at Peace with Myself.

So, I've Fought the Good Fight, sometimes. And, I've Quit Places where I believed my Endeavors were Futile.

You have to make the Decision on Your Course of Involvement, HigginsdogRN, and Reap the Fruits of Your Labor. You know, Deal with the Ramifications of Your Actions or Inactions

A Wise Man once said something like, "If a Town won't have you, shake the dust from your Sandals and move on to the Next Town".

The Very Best to you, HigginsdogRN!

[HigginsdogRN]

Thank you. I know what I must do.

[elkpark]

When I used to survey psychiatric hospitals for my state, some of the state hospitals had situations like the one you describe. There were good management people trying to make serious changes, but, on the units, there were a lot of long-time staff who were used to doing things the way they had always done them and didn't see any reason to change (i.e., didn't see any reason to put forth more than the minimum amount of effort to get through the day). Over time, the management, who were serious about making positive changes, did manage to make a lot of changes for the better.

If you are in a situation where the administration just doesn't know what's going on on the units, or knows and is trying to make positive changes, it may be worth riding things out and trying to help implement positive change. On the other hand, if administration knows and doesn't care, I would get out of there as soon as decently, professionally possible.

No, psych nursing is not like that everywhere.

[Whispera, MSN, RN]

I've worked in three psychiatric hospitals. All three were therapeutic and geared toward helping the patients get to the best possible quality of life.

You landed in a bad spot. My advice is get out of there as quickly as you can if things don't change. In the meantime do what you can to change them. You can be with the patients even if no one else spends time with them. You can be the person who makes a difference.

[HigginsdogRN]

I'm looking. I wonder how I can determine the good from the bad. This facility talked about all the "right" things during the interview. Patient centered care, least restrictive, dignity...the whole spiel. I think the administration knows what's up and don't care. It wouldn't be too hard to figure out the nurses who have the most complaints, initiation of seclusion and restraints and orders for emergency meds.

[MyPrnPleaseBSN]

My friend, RUN!!! I am so sorry you are experiencing this, but no, this is NOT how it is suppose to be. The facility and the environment should be a therapeutic/mileu to provide the best and quality care for the patient just like @Whispera mentioned. Its a shame and unfortunate that some psych nurses like the one you trained with have that type of mentality. Please make sure you don't let their attitude rob on you. Don't let that kill your vibe, Psychiatry is a wonderful specialty, the rewards always outways the challenges if we are blessed to be a in good facility! Good luck

[la_chica_suerte85, BSN, RN]

I'm just a student and I happened to be among the lucky few who got to go to our state psychiatric facility for our psych rotation just this past quarter. It seemed to me it depends on where it is you are in the facility. Acute admissions is tough -- people are fresh from jail (in my case) and are not stable, the county deputies definitely give no ***** about therapeutic communication and the state officers are like, "Therapeutic communication whhhaaaaa?" The nurses had to do what they had to do to get through but even still carried on as professionally and therapeutically as they could.

I would not want to work on those units as a new grad myself or even as a seasoned pro. However, we were floated to other places and it seemed like the staff understood that the milieu was vital to their own safety and to maximizing positive patient outcomes. The patients were more stable in these places and were making progress and the staff and patients alike valued the therapeutic relationships they forged.

So, I think it really comes down to that you got in a bad spot. I have seen some horrible units that made me want to run away from nursing during school -- and then I'd take an elevator ride down to the unit below or above and it would be like dang angels greeting me as the doors parted. Even within facilities the differences can be dramatic.